Creatinine-based renal function estimates and dosage of postoperative pain management for elderly acute hip fracture patients

Morten Baltzer Houlind, Kristian Kjær Petersen, Henrik Palm, Lillian Mørch Jørgensen, Mia Aakjær, Lona Louring Christrup, Janne Petersen, Ove Andersen, Charlotte Treldal

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Abstract

Many analgesics and their metabolites are renally excreted. The widely used Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)-estimated glomerular filtration rate (eGFR) equations are not developed for use in the elderly, while the recent Berlin Initiative Study (BIS), Full Age Spectrum (FAS), and Lund-Malmö revised (LMR) equations are. This observational study investigated differences between creatinine-based eGFR equations and how the choice of equation influences dosage of analgesics in elderly (≥70 years) patients admitted with acute hip fracture. eGFR was calculated by the CKD-EPI, BIS, Cockcroft-Gault (CG), FAS, LMR, and Modification of Diet in Renal Disease (MDRD) equations. Standard daily dose for postoperative pain medications ibuprofen, morphine and gabapentin was simulated for each equation according to dosage recommendations in Renbase®. For 118 patients, mean eGFR from the CKD-EPI, BIS, CG, FAS, LMR, and MDRD equations was 67.3 mL/min/1.73 m 2, 59.1 mL/min/1.73 m 2, 56.9 mL/min/1.73 m 2, 60.3 mL/min/1.73 m 2, 58.9 mL/min/1.73 m 2, and 79.1 mL/min/1.73 m 2, respectively (p < 0.0001). Mean difference to CKD-EPI was −10.4 mL/min/1.73 m 2 to 11.8 mL/min/1.73 m 2. Choice of eGFR equation significantly influenced the recommended dose (p < 0.0001). Shifting to BIS, FAS, or LMR equations led to a lower recommended dose in 20% to 31% of patients. Choice of eGFR equation significantly influenced dosing of ibuprofen, morphine, and gabapentin.

Original languageEnglish
Article number88
JournalPharmaceuticals
Volume11
Issue number3
Number of pages14
ISSN1424-8247
DOIs
Publication statusPublished - 2018

Keywords

  • Analgesic
  • Clinical pharmacy
  • Drug dose adjustment
  • Drug dosing
  • Elderly
  • Glomerular filtration rate
  • Kidney function
  • Pain management
  • Patient safety
  • Renal function

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